Orthopedics:Conditions & Treatments

Tibia (lower leg) Fractures

The tibia, or shinbone, is the most common fractured long bone in your body. The long bones include the femur, humerus, tibia, and fibula. A tibial shaft fracture occurs along the length of the bone, below the knee and above the ankle.

The tibia can break in several ways. The severity of the fracture usually depends on the amount of force that caused the break. The fibula is often broken as well.

Common types of tibial fractures include:

Stable fracture: This type of fracture is barely out of place. The broken ends of the bones basically line up correctly and are aligned. In a stable fracture, the bones usually stay in place during healing.

Displaced fracture: When a bone breaks and is displaced, the broken ends are separated and do not line up. These types of fractures often require surgery to put the pieces back together.

Transverse fracture: This type of fracture has a horizontal fracture line. This fracture can be unstable, especially if the fibula is also broken.

Oblique fracture: This type of fracture has an angled pattern and is typically unstable. If an oblique fracture is initially stable or minimally displaced, over time it can become more out of place. This is especially true if the fibula is not broken.

Spiral fracture: This type of fracture is caused by a twisting force. The result is a spiral-shaped fracture line about the bone, like a staircase. Spiral fractures can be displaced or stable, depending on how much force causes the fracture.

Comminuted fracture: This type of fracture is very unstable. The bone shatters into three or more pieces.

Open fracture: When broken bones break through the skin, they are called open or compound fractures. For example, when a pedestrian is struck by the bumper of a moving car, the broken tibia may protrude through a tear in the skin and other soft tissues. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications and take a longer time to heal.

Closed fracture: With this injury, the broken bones do not break the skin. Although the skin is not broken, internal soft tissues can still be badly damaged. In extreme cases, excessive swelling may cut off blood supply and lead to muscle death, and in rare cases, amputation.

High-energy collisions, such as an automobile or motorcycle crash, are common causes of tibial shaft fractures. In cases like these, the bone can be broken into several pieces (comminuted fracture). Sports injuries, such as a fall while skiing or running into another player during soccer, are lower-energy injuries that can cause tibial shaft fractures. These fractures are typically caused by a twisting force and result in an oblique or spiral type of fracture.

Symptoms

Pain

Inability to walk or bear weight on the leg

Deformity or instability of the leg

Bone "tenting" the skin or protruding through a break in the skin

Occasional loss of feeling in the foot

Treatment

Most injuries cause some swelling for the first few weeks. Your doctor may initially apply a splint to provide comfort and support. Unlike a full cast, a splint can be tightened or loosened, and allows swelling to occur safely. Once the swelling goes down, your doctor will consider a range of treatment options.

Your doctor may recommend surgery for your fracture if it is:

An open fracture with wounds that need monitoring

Extremely unstable because of many bone fragments and large degrees of displacement

Not healed with nonsurgical methods

Surgical treatment options include:

Intramedullary nailing

Plates and screws

External fixation

Recovery

How long it takes to return to daily activities varies with different types of fractures. Some tibial shaft fractures heal within 4 months, yet many may take 6 months or longer to heal. This is particularly true with open fractures and fractures in patients who are less healthy.

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